Bhikkhu Bodhi once told me that Saddha (trust, confidence or faith) is important in dealing with pain. One has to try to find a cure for one's condition but if no cure is forthcoming one has to find some meaningful activity to sustain one's interest and some methods of practice to help one cultivate one's mind and develop wholesome qualities. This is where trust or faith (saddha) is important. One can use it as an opportunity to develop several paramis: patience, equanimity, compassion and loving-kindness for others who are subject to still worse suffering than us; energy in pursuing the good despite the handicap, etc.

He also suggested to me to listen to his lectures 'In the Buddha's Words' and the Majjhima Nikaya series.

For me, I find Buddhanusati very helpful - it lifts the mind up and keeps things going. OR just to recollect what a noble disciple would do when in pain. And it is very enjoyable listening to Dhamma talks by Bhikkhu Bodhi and others. This has become my daily activity and interest..

Another method I find helpful is Metta Bhavana. I don't find that focusing on the pain very helpful as it tends to intensify the pain for me. As I try to put all the attention on pain, it gets really powerful and gigantic. (defilements tend to arise when the mind is narrow or tight) What I find helpful is open minded metta bhavana. (just being open and soft towards it, know it and be 'friendly' towards it, don't harm it etc) This is boundless metta and when the mind is boundless, if greeds/aversions arise, they do not overcome or pervade the mind. And this actually helps physical pain.

I have to do this early though - if I 'catch' it or notice the pain pretty late, then it will last longer and stronger.

Another very helpful method is what I learned from Bhikkhu Ananadajoti's lectures and attitude - anicca or perception of impermanence. It made me realise that I am not 'always' in pain. Or the pain was just really bad a few days ago but it got better a few days later. It's like a river flowing through.. sometimes it hits some rocks and sometimes it doesn't. So it's just a matter of being patient.. To go through this pain with patience, whether it takes one hour or a life time. In this way, I don't get overly excited when I am better and I don't get overly down when I am in pain.

Another very helpful thing Ven Anandajoti taught in his talk is to recollect one's wholesome deeds. Or to recollect one's good qualities. This is not to boost one's ego but to encourage oneself to do more wholesome deeds. This really bring calmness and joy, which I find helpful for both physical and mental pains.

I have also learned that I have to live with it, not fight it or to push it away. There can be very strong mana or conceit when I wanted to 'sit through pain' or biting the teeth to overcome the pain. This is an attitude that I took pain as an enemy.. And of course, I didn't win

Quick Note:I believe (this is an ongoing experiment) Joseph Goldstein's "mantra" "It's okay to be uncomfortable" is working for me the past few days (along with practice, acupuncture, massage and Tylenol in moderation NSAIDs--aspirin, ibuprofen give me abdominal cramps).

Overall, very excellent and practical advice. My initial aversion to the "hippie vision quest" vibe was overwhelmed by the fact the more I listened to her and others share the more I kept thinking, "I'm not alone." This is especially true if you have issues of shame with illness: not the "good" kind we find in the Buddha's advice to his son in MN 61, for instance, but the "bad" kind where you blame yourself for things you can't control (old age, sickness, death, discomfort, chronic pain conditions, etc...). Likewise with the asking for help discussions and DEALING WITH DOCTORS AND OTHER MEDICAL PROFESSIONALS.

Unless you're completely new to Buddhism, you can probably skip the first talk (and probably most of the second); and if you've experience with body scans and/or metta you can probably skip those guided meditations too.

Hi andrewuk,Thanks for your wonderful post. My experience with all those strategies is very similar.

The unpredictability of chronic pain or illness requires us to have as many tools at our disposal as possible. Otherwise, we slip too easily into trying to take it out on others or going from the extreme of thinking that when we're not in pain or have a good day we're cured, and the other extreme of thinking when we're in pain or have a particularly bad day that ALL hope is lost.

Ines Freedman's and Goldstein's advice (above) go into more detail on how to navigate pain in terms of samatha (calming), vipassana (insight), etc.... I personally think Freedman's (drawing on Shinzen Young) Local Intensity/Global Spread and Free Floating In the Discomfort and other techniques exemplify Rev. Thate's wise words.

Either way will do. That is, some who suffer from the pain severer than they can bear will need to fight it off by calm, that is, leaving everything completely out of the consciousness. This is possible. That is , they turn toward calm and free the heart so that it reaches the state of calm fully, becoming altogether unconscious. They can drop themselves in that state for an hour or two. And as soon as the heart withdraws, whatever illness or pain may absolutely disappear....

Therefore, the best way is: When the feeling of suffering occurs, one should contemplate it in accordance with the method of Satipatthana..., so that one is capable of perceiving it indifferently, without possessing such a feeling as part of the self....

[T]he best way is that after we have practiced calm sufficiently, we should learn to contemplate problems. It will be very good to be able to make use of both methods.

I have heard that on one occasion the Blessed One was staying near Savatthi in the Eastern Monastery, the palace of Migara's mother. Now on that occasion the Blessed One, on emerging from seclusion in the late afternoon, sat warming his back in the western sun. Then Ven. Ananda went to the Blessed One and, on arrival, having bowed down to the Blessed One, massaged the Blessed One's limbs with his hand and said, "It's amazing, lord. It's astounding, how the Blessed One's complexion is no longer so clear & bright; his limbs are flabby & wrinkled; his back, bent forward; there's a discernible change in his faculties — the faculty of the eye, the faculty of the ear, the faculty of the nose, the faculty of the tongue, the faculty of the body."

"That's the way it is, Ananda. When young, one is subject to aging; when healthy, subject to illness; when alive, subject to death. The complexion is no longer so clear & bright; the limbs are flabby & wrinkled; the back, bent forward; there's a discernible change in the faculties — the faculty of the eye, the faculty of the ear, the faculty of the nose, the faculty of the tongue, the faculty of the body."

That is what the Blessed One said. Having said that, the One Well-gone, the Teacher, said further:

I spit on you, old age — old age that makes for ugliness. The bodily image, so charming, is trampled by old age.Even those who live to a hundred are headed — all — to an end in death, which spares no one, which tramples all.Samyutta Nikaya 48.41 (Rev. Thanissaro tr.)

I suspect the idea that pain and jhāna, or pain and meditation in general, don't mix is some bull.Best,Daniel

I have heard that on one occasion the Blessed One was staying near Savatthi in the Eastern Monastery, the palace of Migara's mother. Now on that occasion the Blessed One, on emerging from seclusion in the late afternoon, sat warming his back in the western sun. Then Ven. Ananda went to the Blessed One and, on arrival, having bowed down to the Blessed One, massaged the Blessed One's limbs with his hand and said, "It's amazing, lord. It's astounding, how the Blessed One's complexion is no longer so clear & bright; his limbs are flabby & wrinkled; his back, bent forward; there's a discernible change in his faculties — the faculty of the eye, the faculty of the ear, the faculty of the nose, the faculty of the tongue, the faculty of the body."

"That's the way it is, Ananda. When young, one is subject to aging; when healthy, subject to illness; when alive, subject to death. The complexion is no longer so clear & bright; the limbs are flabby & wrinkled; the back, bent forward; there's a discernible change in the faculties — the faculty of the eye, the faculty of the ear, the faculty of the nose, the faculty of the tongue, the faculty of the body."

That is what the Blessed One said. Having said that, the One Well-gone, the Teacher, said further:

I spit on you, old age — old age that makes for ugliness. The bodily image, so charming, is trampled by old age.Even those who live to a hundred are headed — all — to an end in death, which spares no one, which tramples all.Samyutta Nikaya 48.41 (Rev. Thanissaro tr.)

I suspect the idea that pain and jhāna, or pain and meditation in general, don't mix is some bull.Best,Daniel

As I trundle towards my dotage and decrepitude, I can agree with the sentiment: "I spit on you, old age." And I can appreciate this rather human face of the Buddha, just like the last line in the Yasa Sutta.

This being is bound to samsara, kamma is his means for going beyond. -- SN I, 38.

“Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?” HPatDH p.723

>> Do you see a man wise[enlightened/ariya]in his own eyes? There is more hope for a fool than for him.<<-- Proverbs 26:12

tiltbillings wrote:As I trundle towards my dotage and decrepitude, I can agree with the sentiment: "I spit on you, old age." And I can appreciate this rather human face of the Buddha, just like the last line in the Yasa Sutta.

Thanks, Tilt. That's a great sutta. I especially like the end.

the Buddha wrote:But when I am traveling along a road and see no one in front or behind me, at that time I have my ease, even when urinating & defecating.

Elisha Goldstein wrote:Ninety million people in the United States alone suffer from some form of chronic illness. These statistics only speak to physical illnesses and not to emotional ones. The number leaps from there. When Toni Berhnard fell ill in Paris on a trip in 2001, doctors told her she had an acute viral infection, but Toni never recovered. Since that day her illness has become her greatest teacher.

I read Toni Bernhard's book How To Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and Their Caregivers when it came out (but currently have no copy).

I highly recommend this interview by Sylvia Boorstein (and Toni's book) if not just for it's discussions on firing your doctors, navigating the medical-industrial-complex, and everyone and their cat trying to diagnose you. This is personally meaningful to me, as, like Toni, the doctors really don't know how to diagnose me or even what to do with me in general (download).

Other topics include the paradox of hope (for a "cure"), equanimity v. compassion, not getting better.

See also this talk by Toni (not to be confused with her husband, Tony, another dharma teacher): stream or download.

An anthropologist once questioned an Eskimo shaman about his tribe's belief system. After putting up with the anthropologist's questions for a while, the shaman finally told him: "Look. We don't believe. We fear."

In a similar way, Buddhism starts, not with a belief, but with a fear of very present dangers. As the Buddha himself reported, his initial impetus for leaving home and seeking Awakening was his comprehension of the great dangers that inevitably follow on birth: aging, illness, death, and separation. The Awakening he sought was one that would lead him to a happiness not subject to these things. After finding that happiness, and in attempting to show others how to find it for themselves, he frequently referred to the themes of aging, illness, death, and separation as useful objects for contemplation. Because of this, his teaching has often been called pessimistic, but this emphasis is actually like that of a doctor who focuses on the symptoms and causes of disease as part of an effort to bring about a cure. The Buddha is not afraid to dwell on these topics, because the Awakening he teaches brings about a total release from them.

This study guide provides an introduction to the Buddha's teachings on aging, illness, death, and separation. The passages included here — all taken from the Pali canon — are arranged in five sections.

The first section presents medical metaphors for the teaching, showing how the Buddha was like a doctor and how his teaching is like a course of therapy offering a cure for the great dangers in life.

The third section contains passages that use aging, illness, death, and separation, as reminders for diligence in the practice. The central passage here is a set of five recollections, in which recollection of aging, illness, death, and separation forms a background for a fifth recollection: the power of one's actions to shape one's experience. In other words, the first four recollections present the dangers of life; the fifth indicates the way in which those dangers may be overcome, through developing skill in one's own thoughts, words, and deeds. Useful articles to read in conjunction with this section are Affirming the Truths of the Heart, Karma, and The Road to Nirvana is Paved with Skillful Intentions, Faith in Awakening, and The Practice in a Word.

The fourth section contains passages that give specific advice on how to deal with problems of aging, etc. The Buddha's teachings on kamma provide an important underpinning for how problems of pain and illness are approached in this section. Given the fact that the experience of the present moment is shaped both by past and by present intentions, it is possible that — if an illness is the result of present intentions — a change of mind can effect a cure in the illness; but if the illness is the result of past intentions, a change of mind may have no effect on the illness but can at least protect the mind from being adversely affected by it. Thus some of the passages focus how practicing the Dhamma can cure a person of illness, whereas others focus on how the Dhamma can ensure that, even though a person may die from an illness, the illness will make no inroads on the mind. A useful article to read in conjunction with this section is Educating Compassion.

The fifth section gives examples of how the Buddha and his disciples skillfully negotiated the problems of aging, illness, death, and separation.

Ours is a culture that doesn't like to think about illness and death, and as a result, when faced with someone who's sick or dying, we're at a loss as to what to do. Some people will advise you simply to do what feels right, but feelings have a way of turning slippery and devious. Some things feel right simply because they make you feel good, regardless of whether they're genuinely right for the other person. A desire to extend life may mask a deeper fear of your own death; a desire to terminate a miserable illness may rationalize your distress at having to witness suffering. Even if you're told to act from a place of mindful presence, you may find that what seem to be your spontaneous inspirations are actually conditioned by hidden, unexamined assumptions about what life and death are all about.

This is why the simple injunction to be compassionate or mindful in the presence of a sick or dying person isn't enough. We need help in educating our compassion: specific advice on how to think through the implications of our actions in the face of life and death, and specific examples of how people who have contemplated these issues thoroughly have actually acted in the past.

With this thought in mind, I searched through the Pali canon — the oldest extant record of the Buddha's teachings — to see what lessons could be drawn from the Buddha's example. After all, the Buddha often referred to himself as a doctor, and to his Dharma as medicine for the sufferings of the world. From his point of view, we're all sick and dying on a subtle level, so we all deserve continual compassion. But what sort of advice did this doctor give when face-to-face with the flesh and blood suffering of illness and death? How did he treat people who were physically sick or dying?

If, for example, you're a doctor in an emergency room faced with a patient complaining of chest pains, you have many quick decisions to make. You have to decide which tests to conduct, which questions to ask the patient, and which physical symptoms to look for, before you can diagnose the pains as a sign of indigestion, an incipient heart attack, or something else entirely. You also have to decide which questions not to ask, so as not to get waylaid by extraneous information. If you focus on the wrong symptoms, the patient might die — or might spend a needless night in the intensive care unit, depriving a patient with a genuine heart attack of a bed. Once you've made your diagnosis, you have to decide which course of treatment to follow and how to keep tabs on that treatment to see if it's really working. If you frame the symptoms in the wrong light, you can do more harm than good. If you frame them in the right light, you can save lives.

The same principle applies in solving the problem of suffering, which is why the Buddha gave prime importance to the ability to frame the issue of suffering in the proper way. He called this ability yoniso manasikara — appropriate attention — and taught that no other inner quality was more helpful for untangling suffering and gaining release (Iti 16).

In giving his most detailed explanation of appropriate attention (MN 2), he starts with examples of inappropriate attention, which center on questions of identity and existence: "Do I exist?" "Do I not?" "What am I?" "Did I exist in the past?" "Will I exist in the future?" These questions are inappropriate because they lead to "a wilderness of views, a thicket of views" such as "I have a self," or "I have no self," all of which lead to entanglement, and none to the end of suffering.

In contrast, the Buddha then depicts appropriate attention as the ability to identify that "This is suffering (the Pali word dukkha here covers stress and pain as well)," "This is the origination of suffering," "This is the cessation of suffering," and "This is the path of practice leading to the cessation of suffering." These are the four categories that the Buddha, in his first discourse, called the four noble truths. The ability to frame the issue of suffering in line with these categories is what enables you ultimately to put an end to the problem of suffering once and for all. This is why they're appropriate.

The most obvious lesson to be drawn from this way of distinguishing inappropriate from appropriate attention is that inappropriate attention frames the issues of the mind in terms of abstract categories, whereas appropriate attention frames them in terms of things that can be directly pointed to in immediate experience as "This... This... This... This." Ideas of identity and existence are basic to abstract thinking, and many philosophers have maintained that they lie at the basis of any spiritual quest. The Buddha, however, noted that the thought, "I am the thinker" lies at the root of all the categories and labels of conceptual proliferation, the type of thinking that can turn and attack the person employing it. These categories are notoriously hard to pin down, often dissolving into arbitrary semantics. "Do I exist?" — It depends on what you mean by "exist." "Do I have a self?" — It depends on what you mean by "self." Thinking driven by definitions like these often falls prey to the hidden motives or agendas behind the definitions, which means that it's unreliable.

However, suffering is something directly knowable: preverbal, private, but universal. In framing the issues of the mind around suffering, the Buddha bases his teachings on an intention totally trustworthy — the desire for his listeners to put an end to all their suffering — and focuses on something not dependent on definitions. In fact, he never offers a formal definition of the term "suffering" at all. Instead, he illustrates it with examples — such as the suffering of birth, aging, illness, and death — and then points out the functional element that all forms of mental suffering share: clinging to the five aggregates of form, feeling, perception, mental fabrication, and consciousness. The clinging is not the totality of the suffering, but it's the aspect of suffering most useful to focus on for the purpose of bringing the suffering to an end.

Although there is a passage where the Buddha defines clinging as desire-passion (SN 22.121), he never describes precisely what desire-passion is. In what is apparently the oldest part of the Canon, the Atthaka Vagga (Sn 4), he fills a long discussion of clinging with puns and word play, a style that discourages attempts at systematic, set definitions and the conceptual proliferation they can foster. What this means is that IF YOU WANT TO REFINE YOUR UNDERSTANDING OF clinging, desire-passion, and SUFFERING, you can't cling to words or texts. YOU HAVE TO LOOK DEEPER INTO YOUR PRESENT EXPERIENCE.